Silent Horner Syndrome

Background

Horner syndrome is clinically suspected when the patient demonstrates pupillary miosis and ipsilateral upper lid ptosis. Occasionally, an isolated ptosis or isolated anisocoria is the only clinical sign of the oculosympathetic defect of Horner syndrome [1], [2]. We present two patients with transient anisocoria and ptosis to highlight the importance of maintaining clinical suspicion of the diagnosis even if the miosis and ptosis disappear, as the oculosympathetic defect may persist subclinically.

• References

• 1 Slavin M. Horner syndrome with equal-sized pupils in a case with underlying physiologic anisocoria. J Neuroophthalmol 2000; 20: 1-2
• 2 Maloney WF, Younge BR, Moyer NJ. Evaluation of the causes and accuracy of pharmacologic localization in Hornerʼs syndrome. Am J Ophthalmol 1980; 90: 394-402
• 3 Kardon RH, Denison CE, Brown CK et al. Critical evaluation of the cocaine test in the diagnosis of Hornerʼs syndrome. Arch Ophthalmol 1990; 108: 384-387
• 4 Cremer SA, Thompson HS, Digre KB et al. Hydroxyamphetamine mydriasis in Hornerʼs syndrome. Am J Ophthalmol 1990; 110: 71-76
• 5 Cragg JJ, Krassioukov AV. Pearls and oysters: transient Horner syndrome associated with autonomic dysreflexia. Neurology 2013; 81: e35-e37